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The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

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Final rept. Dec 2000-Nov 2001

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Each year an estimated one million women elect to have surgical sterilization. This is performed by a laparoscopic procedure which can be severe enough to warrant an unplanned admission. With an increased understanding of the physiological basis of pain, classes of drugs not normally associated with pain reduction are now being investigated based on their ability to interact with receptors in the pain pathway. Experimental studies have shown that the N-methyl-D-aspartate NMDA receptor plays a significant role in neuronal wind-up, a state of hyperalgesia that can last from hours to days following injury or trauma. Interfering with the NMDA receptor prior to surgical stimuli, wind-up is prevented resulting in decreased pain and analgesic requirements following surgery. Dextromethorphan, a readily available nonopioid antitussive in clinical use for more than 40 years, is one such NMDA receptor Anticosti. This prospective, randomized, double blind pilot study compared the effects over time when patients received dextromethorphan versus placebo-emptively. The sample was comprised of 14 subjects undergoing laparoscopic tubal ligation under general endotracheal anesthesia at regional military medical center for the Pacific Basin. Patients were ASA physical category I or II and at least 18 years of age and assigned to one of two groups. Group I received 60 mg of dextromethorphan orally, and Group II received an oral placebo. Postoperative pain was assessed using an 11 point Numeric Rating Scale NRS at eight time intervals. Additionally, a follow-up questionnaire and 48-hour postoperative telephone call were used to collect data on the patients satisfaction of being in the study. The Students t-test was used to determine homogeneity between the two groups. Following analysis, a statistically significant difference was found in two areas. Patients who received dextromethorphan 60 mg orally before surgery had a significant decrease in postoperative pain p 0.04.7

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Pharmacology

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